Allergic Rhinitis

Paediatric Otolaryngologist Havas' Room

Is your child suffering from Allergic Rhinitis?

We would like to help you understand more about "Allergic Rhinitis in Children". Online research, however, is not an effective way to help your child. Make sure you bring your him/her to see the best ENT specialist!

Professor Havas is one of the few specialists who has post-fellowship training in Paediatrics, leading university affiliations and public hospital appointments. He was an appointed Visiting Otolaryngologist at Sydney Children's Hospital. If you want to bring your child to see him, please give us a call or use the "Book an Appointment" form after you get a referral letter from your local doctor.

What is Allergic Rhinitis?

Allergic rhinitis, together with post-nasal obstruction due to adenoid hypertrophy, is the most common cause of blocked nose in children. It is a condition characterized by inflammatory swelling of the nasal mucus membrane. Clinical diagnosis is based on the presence of symptoms such as; itching, sneezing, blockage or discharge.

Blocked nose for a long time is not good, because rather that breathing warm, filtered humidified air, children breath cold non-filtered non-humidified air which irritates their airways. In addition, long periods of time with a mouth-open posture affect how your face and teeth grow and develop.

Most allergic rhinitis in children is perennial, and is driven by hypersensitivity to house dust mite.


Management of Allergic Rhinitis in Children

Allergic Rhinitis in Children

Most of the exposure to house dust mite occurs in children’s beds.

By way of simple prophylaxis, we suggest the following:

  • Reduce the number of fluffy toys in the room.
  • Wash all bed linen in hot rather than cold water.
  • Consider getting impermeable pillowslip covers, mattress covers and doona covers.
  • Surface dust daily.

These simple measures should cut down exposure to house dust mite by about 50 percent.

Every morning, we recommend the use of a low-flow commercially available salt-water spray.

The main stay of treating allergic rhinitis medically is the use of a low-dose water based surface acting steroid spray. These sprays, by and large, are not recommended for the manufacture for children under 12, which does cause certain problems.

Although they are widely used in the paediatric population, detailed discussion with the parent needs to be undertaken about the possible risks associated with using these sprays. The sprays have to be used regularly and the biggest problem is lack of compliance or regular use.

If the sprays are regularly used, they are not absorbed systemically, and the chance of causing thinning in the lining of the nose is less than one in one thousand. If this happens, there is spotty bleeding and the changes are reversible if the sprays stop.

The chance of the spray contributing to supra-infection with bacterial fungi is so low as to be almost incalculable.

Oral antihistamines in children, even the new and non-sedating oral anti-histamines, do not cause decongestion of the nose. They are drying agents and are useful seasonally for sneezing, watery nose or itchy runny eyes.

The new classes of anti-inflammatory agents, like Singulair, have in some studies been shown to reduce the size of adenoid tissue and to be a useful adjunct in the medical management of allergic rhinitis in children.


Allergic Rhinitis Treatments

There is no doubt that surgical treatment of allergic rhinitis has a significant contribution to make in the 15 to 20% of individuals whose symptoms cannot be controlled with maximal medical management.

Traditionally surgery has been aimed at reducing the mass of the inferior turbinates to;

  • Increase nasal cross-sectional area;
  • Increase nasal airflow;
  • Decrease sensation of nasal obstruction;
  • Decrease mucus hypersecretion.

Outfracture of the Inferior Turbinates

This is perhaps the oldest surgical technique. It is a relatively simple procedure that is rarely done in isolation, but is usually combined with other nasal procedures. If used alone it affords symptom amelioration measured in months rather than years and is not a recommended current definitive treatment.

Mucosal or Sub-Mucosal Diathermy of the Inferior Turbinates

Sub-mucosal diathermy is the preferred route insomuch as it causes no mucocilial scarring and does not interfere with mucocilial transfer. The erectile tissue between the bone of the inferior turbinate and the lining is obliterated by electrocautery with scarring. This technique involves an electrical burn; the burn is not controlled and often some damage to the mucosa occurs. It is associated with significant perioperative swelling and it is not common (?) to get scabbing or eschar of the inferior turbinate separating approximately one week post-operatively. Amelioration of symptoms is measured in months to years. The major disadvantages of this technique are;

  • Post-operative crusting and scarring of the nose;
  • Procedure performed under general anaesthesia;
  • Procedure performed in a hospital setting;
  • Most long-term studies indicate significant therapeutic effect for 2 years with diminution in benefit thereafter.

Radiofrequency Ablation

Radiofrequency ablation can be either unipolar or bipolar. This is a newer technique using electrical energy at different frequency/intensity. The bipolar technique has the advantage of not spilling current into adjacent tissues. Controlled radiofrequency obliteration of erectile tissue occurs with minimal thermal damage to the underlying bone and periosteum or the overlying mucosa. Follow up results indicate symptom amelioration in years. The advantage of this technique is that it can be performed under local anaesthesia in an office setting. The disadvantage is that the technology itself is relatively expensive and the disposable probe costs up to $500.00 per procedure.

Laser Reduction of Interior Turbinates

This can be performed using either carbon dioxide or argon lasers. Laser reduction is a transmucosal technique with attendant risk of damage to the mucosa and subsequent disruption of mucocilial transport. Follow up studies of laser turbinate reduction shows good symptom amelioration for up to 2 years with reduction in benefit thereafter. The major disadvantage of this technique is the expense of the laser technology. The procedure is usually performed under anaesthesia in a hospital setting, but can be performed under local anaesthesia in an office setting.

Inferior Turbinoplasty using Powered Instrumentation

This is one of the newer techniques for controlling hypertrophy of the inferior turbinates associated with allergic rhinitis. It is a sub-mucosal technique whereby the erectile tissue, periosteum and bone can be removed with minimal mucosal damage. This technique is often combined with outfracture of the inferior turbinates. It is usually performed under general anaesthesia in a hospital setting. Follow up studies show that symptoms are ameliorated for years. Some of the longest running studies have shown excellent symptom amelioration at 3 and 4 years post-operatively. Another advantage of this technique is that there is minimal crusting or eschar in the nose and the benefits of the operation tend to “kick in” on the 3rd or 4th post-operative day. The disadvantage of the technique is that it is performed under general anaesthesia in a hospital setting. The disposable blade used to perform the procedure is relatively inexpensive.

Turbinectomy

Excision of part, or all of the inferior turbinate is one of the older techniques for treating allergic rhinitis. It involves the surgical excision of mucosa, sub-mucosa, erectile tissue and bone. There are two basic techniques; removing the front end of the inferior turbinates or significantly trimming the turbinate along its entire length. Symptom amelioration is excellent and studies have shown significant benefits being recorded for more than 5 years post-operatively.

The disadvantage is that the technique is performed under general anaesthesia In a hospital setting and it is associated with a higher risk of secondary haemorrhage than other surgical techniques. Because it gives the greatest increase in nasal cross-sectional area, theoretically problems with a hyper-patent nose, potentially leading to atrophic rhinitis in colder climates have to be considered.